Antithrombic pharm for ischemic HD Flashcards
indications bivalirudin
UA pt ungergoin percutaneous coronary intervention
lifespan of platelet
7-10 days
indications aspirin
UA acute MI, hx of MI
decreases futur MI and mortality
pharmacokinetics clopidogrel, ticlopidine, prasugrel
clopidrogrel, ticlopidine and prasugrel metabolized to active metabolite (prasugrel more readily metab, stronger)
clopidrogrel metabolized by CYPC19
side effects ticlopidine
life threathening AE - neutropenia, thrombotic thrombocytopenic purpura
conversion of extrinsic and intrinsic pathway
Xa
warfarin inhibits ___ synthesis
prothrombin, VII IX, X,
general treatment for NSTEMI and UA
antiplatelet/antithrombotic
statin
aspirin
B block
nitrates
antithrombotic agens
unfractionated heparin
low MW heparin
direct thrombin inhibitors
general reperfusion therapy+therapy for STEMI
Mechanical or thromboyltic reperfusion
and
antiplatelet/antithrombotic, statin, aspin, beta blockers, nitrates
Alteplase mechanism
activates plasminogen into active protease to lyse fibrin clots
mechanism of thienpyridines (ticlopidine, prasugrel, ticagrelor)
inhibit ADP meidated activaion of platelets (at PY12 receptor to block decrease in cAMP and subsequnet increase in calcium)
mediates fibrinogen to fibrin
thrombin
pharmacokinetics Abciximab and Eptifibatide
Abciximab is IV admin and non-competitive
Eptifibatide is IV admin, competiive, renal clearance
Glycoprotein IIb/IIIa inhibitors
Abciximab
Epitifabatide
new oral anticoagulants,
reduce risk of stroke and Syst. embolism in pt with nonvalvular Afib,
reduce risk of recurrent ischemia after ACS event (thrombin remains elevated following ACS event)
dabigitran
rivaroxaban
prothrombin factor
(II)
aspirin impact on endothelial
inhibits COX1, but endothelial have nucleus and can regenerate and can produce prostacyclin to work against platelet aggregation (against thromboxane and clotting)
Cox inhibitor
Aspirin
digest fibrin, other plasma proteins
Plasmin
patients do not benefit from fibrinolytic therapy
UA or STEMI
factors inactivated by heparin
XII
XI
IX
X
VII
Thrombin
exception to antirombotic/antiplatelet treatment rule: ___ may also be treated with thrombolytic
STEMI
activates plasminogen
t-PA
heparin inactivates
only circulating thrombin (not bound)
factors dependent of vitK for synth
II IX X VII
recombinant tissue type plasminogen activators for fibrinolytic therapy
Alteplase
LMWH and fondaparinux advantage over UFH
more predictable bioavail
longer half life
reversible thienopyridine
ticagrelor
adverse effects alteplase
bleeding
systemic lytic state
indications abciximab
PCI (angioplasty,stent)
combo with aspirin or heparin/LMWH
with alteplase for thrombolysis
ADP receptor inhibtors
Clopidogrel
Prasugrel
Ticagrelor
mechanism Abciximab and eptifibatide
inhibit common pathway of platelet aggregation (binding GPIIb/IIIa receptors to fibrinogen and vWF)
birect thrombin inhibitor
bivalirudin (independent of anatithrombin) (clotted and free thrombin)
indications epitifibatide
PCI (angioplasty or stent)
UA and MI, often along with LMWH
UFH and LMW heparins pharomacokinetics
parentally admin (not absorbed from GI)
mechanism, indication Dipyridamole
inclrease platelet cAMP blocking phosphodiesterase and blocking cell uptake+destruction of adenosine
little therapeutic use alone, Pts with aspriin intollerance
